Policy Terms Below
Medical Insurance - How the New Zealand Health System Works
Ever Considered Health ad Medical Insurance? In New Zealand we have available both public and private healthcare. The public system provides care for acute conditions, which can hit all of us without warning. Unfortunately the public health system does not receive enough funding to provide treatment for everyone on demand. Therefore non-acute conditions must first be assessed before treatment can be offered. This includes such conditions as hip/knee replacement, hysterectomy, heart surgery, cancerous tumor, cataract removal and diagnostic services such as MRI and CT scans, colonoscopy, laparoscopy etc. Waiting times for such procedures can often take up to a year or longer, if eligibility for treatment is accepted. A condition left untreated can cause unnecessary long-term suffering and worry.
Medical Insurance is therefore designed to give you peace of mind with expert medical treatment where or when you need it. You are not at the mercy of the New Zealand public health systems or long hospital waiting lists.
Ok, I have decided I want medical/health insurance so what can you offer me?
With an OnePath Medical Extra policy we can offer you the following:-
This means OnePath Life guarantees the terms and conditions of your policy for the life of your policy.
You can choose the amount of excess you would like to deduct from any medical costs reimbursements - the higher the excess, the lower the premiums.
Savings and Excess
This product enables you the ability to include a savings component should you wish to add this to your policy.
Reimbursement of costs directly arising from surgical treatment of non-acute medical conditions carried out in a private hospital. Maximum benefit per life assured is $200,000 per operation.
Reimbursement of costs directly arising from admission to a private hospital for non-surgical treatment of a non-acute medical condition - maximum benefit per life assured is $200,000 per annum. Included in this coverage are treatment costs for major illness such as cancer, irrespective of whether these costs are subsidised by Pharmac or not.
Reimbursement of the following major diagnostic procedures – maximum benefit payable per life assured is $200,000 per annum:
- MRI and CT Scans
- Dilation and Curettage
Post-Admission Home Nursing Care
Reimbursement of costs arising from home nursing care by a registered nurse, which has been recommended following admission to a private hospital. Maximum benefit payable per life assured is $300 per day up to maximum of 10 days.
Support Person Accommodation
Reimbursement of support person accommodation costs where the life assured must travel outside of their residential area for treatment that cannot be provided locally. Maximum benefit payable per life assured is $300 per day up to a maximum of 10 days.
Support Person Transfer Costs
Reimbursement of support person transfer costs where the life assured must travel outside of their residential area for treatment that cannot be provided locally.
Reimbursement of medical, travel and support person costs where recommended treatment cannot be provided in New Zealand. Maximum benefit payable per life assured is $30,000 per annum.
Overseas Waiting List Benefit
Reimbursement of the usual, customary and reasonable costs which would be payable in New Zealand for the same treatment or procedure for any overseas medical, travel and support person costs which arise as a result of the recommended treatment being able to be provided in New Zealand but not within 6 months of the time recommended by your specialist, as a direct result of insufficient medical resources. Maximum benefit payable per life assured is $200,000 per annum.
Optional Specialists Costs
Reimbursement of specialist’s consultation costs not otherwise covered by the surgical and non-surgical hospitalization benefits - maximum benefit payable per life assured is $3,000 per annum.
Includes GP-referred consultations with registered:
Optional Diagnostic Tests
Reimbursement of diagnostic procedures and test costs not otherwise covered under the surgical and non-surgical hospitalization benefits - maximum benefit payable per life assured is $3,000 per annum.
If you incur one of the medical costs covered under this Medical Extra Cover while you are in Australia for any reason, then OnePath Life will reimburse you up to the usual, reasonable and customary New Zealand costs for the same treatment.
Public Hospital Cash Grant
If you require treatment through a public hospital and your hospital stay exceeds 3 nights, then OnePath Life will pay you $300 for each extra night that you stay in hospital up to a maximum of 10 nights.
If the treatment you require is not available locally, then the costs of air or road ambulance transfers to or from a private hospital will be covered.
Funeral Support Benefit
A lump sum of $3,000 (reduced to $2,000 if the covered person is 10 years or younger) payable upon the death of any person covered under this Medical Extra policy. This amount is to assist the family with the immediate expenses associated with the death of a life assured.
If you know you need treatment, you can contact OnePath Life to arrange a pre-approval letter to be provided to you. When you give this letter to your treatment provider they will send the bill directly to us and you will not have to pay first to seek reimbursement from us later.
Children receive automatic free coverage for the first 3 months after being born subject to an exclusion for congenital disorders. Should you wish your child to be covered after the first 3 months you must advise OnePath Life the child’s details prior to the expiry of the free coverage period.
Children may remain covered under your policy for as long as you choose to pay the premium.
- Self-inflicted harm including attempted suicide, alcohol or drug abuse
- War whether declared or not
- Complications of pregnancy lasting less than 90 days after the end of pregnancy
- Participation in a criminal act
- HIV, AIDS and related conditions
- Mental disease or disorder of psychiatric conditions
- Geriatric conditions or senility
- Acute admission to a public or private hospital
- Cosmetic surgery or procedures
- General Practitioner's costs
- Dentist's costs
- Prescription costs except where they are covered under the surgical and non-surgical hospitalization benefits.
- Preventative treatment
- Infertility treatment
- Sterilization costs incurred within 2 years of the commencement date
- Medical costs covered by ACC
- Costs incurred outside Australia and New Zealand except those covered under the Overseas Treatment benefit.
- Laser eye treatment
- Public Hospital treatment, unless as a fee paying Private Patient
- Congenital disorders
- Any treatment which has not been approved for marketing in New Zealand
- Any treatment which OnePath Life does not recognize as the appropriate treatment for the condition
- The funeral support benefit will not be paid if the life assured commits suicide within 13 months of the commencement date of their cover.
Client Membership Benefits
Client membership benefits are designed to help you protect what you wish to insure. You buy insurance so that you know, for example, that you can be assured of an income if you become disabled. However, if you could avoid becoming disabled, that would be best of all. While many chances in life are just that – sometimes unhappy chance – there are areas where we can help you to prevent problems and maintain the lifestyle that you wish to protect.
As life becomes more complicated, we often need the support and advice of professionals to find our feet in difficult times. Your OnePath Life Adviser can offer you free access to individual services that you believe may be required from time to time. Such lifestyle support services include:
- Small Business Consultancy
- Grief or Anxiety Counseling
- Budgeting Advice
- Career Counseling and Job Search
- Health Management
Your OnePath Life Adviser can also give you access to seminars on important subjects from experts in fields such as:
- Genetic Developments
- Youth Suicide Prevention
- Small Business Management
- Career Management
With expert advice and support it is possible to reduce your risk of financial problems, depression, heart disease and many of the causes of disability. As a member of OnePath Life, you can actually work on prevention – while having the security of financial protection. We see our products as the financial safety net at the bottom of the cliff – our membership benefits are a safety barrier at the top of the cliff.
Medical Extra Cover Details
Your premium will adjust on each policy anniversary in line with your increasing age and any underlying premium rate increases.
The minimum monthly premium payable for this policy is $20.00.
Your total premium will include a policy fee, which may change from time to time but which is presently $6.00 per month.
You may choose your premium frequency from weekly, fortnightly, monthly, quarterly, half-yearly or yearly. Premiums that are payable yearly or half-yearly are easier for us to administer, so we will discount your premiums by 5% if you choose either of these premiums frequencies.
You can also choose the day of the week or month on which you wish your premiums to be paid.